Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
Gut. 2010 Sep;59(9):1169-77. doi: 10.1136/gut.2010.210229. Epub 2010 Jun 4.
Endoscopic resection is safe and effective to remove early neoplasia (ie,high-grade intra-epithelial neoplasia/early cancer) in Barrett's oesophagus. To prevent metachronous lesions during follow-up, the remaining Barrett's oesophagus can be removed by stepwise radical endoscopic resection (SRER). The aim was to evaluate the combined experience in four tertiary referral centres with SRER to eradicate Barrett's oesophagus with early neoplasia.
Retrospective cohort study.
Four tertiary referral centres.
169 patients (151 males, age 64 years (IQR 57-71), Barrett's oesophagus 3 cm (IQR 2-5)) with early neoplasia in Barrett's oesophagus < or = 5 cm, without deep submucosal infiltration or lymph node metastases, treated by SRER between January 2000 and September 2006.
Endoscopic resection every 4-8 weeks, until complete endoscopic and histological eradication of Barrett's oesophagus and neoplasia.
According to intention-to-treat analysis complete eradication of all neoplasia and all intestinal metaplasia by the end of the treatment phase was reached in 97.6% (165/169) and 85.2% (144/169) of patients, respectively. One patient had progression of neoplasia during treatment and died of metastasised adenocarcinoma (0.6%). After median follow-up of 32 months (IQR 19-49), complete eradication of neoplasia and intestinal metaplasia was sustained in 95.3% (161/169) and 80.5% (136/169) of patients, respectively. Acute, severe complications occurred in 1.2% of patients, and 49.7% of patients developed symptomatic stenosis.
SRER of Barrett's oesophagus < or = 5 cm containing early neoplasia appears to be an effective treatment modality with a low rate of recurrent lesions during follow-up. The procedure, however, is technically demanding and is associated with oesophageal stenosis in half of the patients.
内镜下切除术是安全有效的，可用于治疗 Barrett 食管中的早期肿瘤（即高级别上皮内瘤变/早期癌症）。为了预防随访期间的同时性病变，可以通过逐步根治性内镜下切除术（SRER）来切除剩余的 Barrett 食管。本研究旨在评估四家三级转诊中心的综合经验，以通过 SRER 根除具有早期肿瘤的 Barrett 食管。
回顾性队列研究。
四家三级转诊中心。
169 例患者（151 例男性，年龄 64 岁[IQR 57-71]， Barrett 食管长度 3 cm[IQR 2-5]），这些患者的 Barrett 食管中存在早期肿瘤<或=5 cm，无黏膜下深层浸润或淋巴结转移，于 2000 年 1 月至 2006 年 9 月期间接受了 SRER 治疗。
每 4-8 周进行一次内镜下切除术，直到完全根除 Barrett 食管和肿瘤的内镜和组织学表现。
根据意向治疗分析，在治疗结束时，97.6%（165/169）和 85.2%（144/169）的患者完全根除了所有肿瘤和所有肠化生。1 例患者在治疗期间肿瘤进展并死于转移性腺癌（0.6%）。中位随访 32 个月（IQR 19-49）后，分别有 95.3%（161/169）和 80.5%（136/169）的患者持续根除了肿瘤和肠化生。1.2%的患者出现急性、严重并发症，49.7%的患者出现症状性狭窄。
对于<或=5 cm 的 Barrett 食管伴早期肿瘤，SRER 似乎是一种有效的治疗方法，随访期间复发率较低。然而，该操作技术要求较高，并且一半的患者会发生食管狭窄。
